Permanent Implantable Cardiac Support Systems.

Abstract

BACKGROUND:

Nearly 1000 permanent ventricular assist devices (VADs) are implanted in patients with severe congestive heart failure in Germany each year. VADs are miniaturized centrifugal pumps that generate continuous blood flow; they are powered and controlled through a cable that passes through the skin. Para- corporeal systems are only rarely implanted, usually in children.

METHODS:

In this selective review of the literature, including guidelines and registry data, we discuss the indications, therapeutic effects, and complications of permanently implantable cardiac support systems.

RESULTS:

The optimal time for VAD implantation cannot be precisely defined. A comparative assessment of the various available systems is not possible, as no randomized trials have been performed on this topic. Registry data indicate that 69% to 81% of patients survive one year after VAD implantation, which is signifi- cantly better than the natural course of (conservatively treated) severe congestive heart failure. The distance patients are able to walk is 129 to 220 m longer at six months, depending on the system implanted. Scores on the EQ-5D health status questionnaire are 28 to 37 points better at six months. The potential severe compli- cations include infection, right-heart failure, hemorrhage, pump thrombosis, stroke, and death.

CONCLUSION:

A VAD system can be implanted as an alternative to cardiac transplan- tation or as a bridging treatment until the patient can be listed for transplantation and receive the transplant. Because of the organ s , only a minority of VAD patients ever receive a transplant.

• Authors: Jan F Gummert, Axel Haverich, Jan D Schmitto, Evgenij Potapov, René Schramm, Volkmar Falk
• Journal: Deutsches Arzteblatt international (Dtsch Arztebl Int) Vol. 116 Issue 50 Pg. 843-848 (12 13 2019) ISSN: 1866-0452 [Electronic] Germany
• PMID: 31931951 (Publication Type: Journal Article, Review)

Topics

• Germany
• Heart Failure (surgery)
• Heart-Assist Devices
• Humans
• Registries
• Treatment Outcome